IKM.Nutrition through The Life Course.15.07.2024.pptx

EWFDEWWFW

1. Nutrition through The Life Course AP Dr Nugroho Abikusno , MD, MS, DrPH, C. Gerontol . & Geriatr . INIA, UN-Malta Emeritus professor Centers for Geriatrics & Nutritional Science Studies Universitas Trisakti

2. LO Nutrition through The Life Course: Pregnancy & Neonatal Nutrition Child Nutrition Adolescent Nutrition Adult Nutrition Nutrition in old age

3. Nutrition Food intake is metabolized through digestion and absorption facilitated by enzymes through out the gastrointestinal tract and together with the involvement of secretory organs such as the salivary glands, liver, pancreas, and gall bladder at each segment of the GI Tract that eventually breaks down major nutrients into their components of sugars, amino acids, fats, vitamins and minerals for the purposes of producing energy for body vital functions, tissue building for immunity and musculature of body and soft tissue of appendages as well as important hormones, enzymes, neuro-transmitters and biomarkers in the body.

4. The Life Course approach (2014) In order to achieve an individual’s optimal health and nutrition status interventions should be focused on an individual at the earliest stage of life as possible beginning in the mother’s womb until old age ( Ageing & Longevity ). These Stages in Life are: Pregnancy and Neonatal Life Childhood Adolescence Adulthood Old age Ageing & Longevity)

5. Nutrition Status Nutrition Status of an Individual is determined by measuring several components in order to diagnose the current nutritional state namely: Clinical assessment , as well as current and previous Life history Anthropometric assessment consisting of important proportions of body parts such as head, arm, waist and calf as well as weight and height compared to a standard in the population Dietetic assessment of food intake by frequency, amount and weight Biochemical assessment of important biomarkers related to nutrition such as hemoglobin, iron, folate and other important nutrients in the body Functional assessment of nutrition status related to nutrition and/ disease

6. Pregnancy & Neonatal Life Nutrition Status When a mother is pregnant and later after delivery, breastfeeding the infant the amounts and variety of food intake increases dramatically In pregnancy 2,100 – 2,300 calories per day in each trimester incrementally In lactation 2,500 calories per day Nutrition assessment In pregnancy increase in body weight each trimester Fundal height in each trimester Intervention High Calorie & High Protein Diet

7. Serum Iron during Pregnancy Hemoglobin levels > 11 grams/ dL 3-6 months pregnancy 10.5 grams/ dL Iron deficiency anemia Ferritin <40 ng/ mL during pregnancy If mother is not anemic Ferritin <15 ng/ mL Hemoglobin < 11 g/ dL Hematocrit < 33 %

8. Childhood Nutrition Status Malnutrition: (45 % of mortality) Stunting (low H/A) Wasting (low W/H) Underweight (low W/A) Overweight Obesity Related to heart, stroke, diabetes, cancers Micronutrient deficiency: iron, vitamin A

9. Childhood (2) Nutrition assessment Anthropometry and compare to WHO standard ( + 2 SD z-score) Intervention Pregnant mother adequate Caloric and Protein intake Routine antenatal care focusing on serum Iron and Folate Pregnancy exercise (flexibility & strength perineum & lower extremities) Infant delivered with full term and normal weight ( > 2,500 gr)

10. Childhood (2) Intervention Initial breast feeding (colostrum) Exclusive breast feeding (3-6 months) Complementary feeding (up to 12 months infancy) Basic immunization Routine monthly health growth and development monitoring Brain growth & development in brain cell number (12 mo ) and hypertrophy (13 to 18 th mo )

11. Adolescence Nutrition Status Anemia in girls Menarche Bulimia and Anorexia ( Eating disorders ) Nutrition assessment Serum iron 60 – 140 mcg/ dL Intervention High Calorie and Protein diet

12. Adolescence (2) Supplementation Ferrous sulphate 325 mg daily (65 mg elemental iron) Low dose 15 -20 mg elemental iron Ferrous gluconate 325 mg daily (35 mg elemental iron) Vitamin C 500 units once daily Avoid tea and coffee

13. Adulthood Nutrition Status Overweight Obesity (abdominal syndrome) Complications : stroke, sleep apnea, snoring, asthma, heart, diabetes, dyslipidemia, HTN , fatty liver, pancreas, infertility, arthritis, varicose veins, gout Nutrition assessment ( Asian criteria ) BMI = W (in kg)/ H ( m 2 ) Overweight BMI 23.0 – 27.5 Obese BMI > 27.5 Intervention Lowering current body weight: Lowering intake of sugar, rice and flour, and Exercise, Intermittent Fasting, Mindfulness

14. Metabolic syndrome Large waistline (90 cm for males; 80 cm for females) High triglyceride level (> 150 mg/dL) Reduced HDL-cholesterol < 40 mg/dL (M); <50 mg/dL (F) Increase blood pressure (SBP > 140; DBP > 80) Elevated fasting blood sugar (prediabetes: 100-125 mg/dL)

15. Old age Nutrition Status Frailty: weight loss, weakness ( frailty ), fatigue, and Sarcopenia (loss of muscle mass) Decrease in food intake, gait abnormalities, osteopenia Nutrition assessment BMI using knee height as proxy then convert into Height by using the Chumlea equation (R Gibson, Nutrition Assessment, Oxford, 2005) Intervention Healthy lifestyle behavior

16. Healthy lifestyle behavior Nutrition eat less but frequently and high quality foods Exercise regularly especially in the morning, 30 minutes of morning sunshine between 6-10 AM to convert vitamin D for muscle and bone strength and increase HDL-cholesterol. Early morning yoga exercise by Kegel , squatting and lateral upper extremity movement to strengthen spinal bone structure to prevent osteoporosis and improve brain blood circulation. Get enough sleep 6 hours during the evening and early morning (10 pm – 3 am) to enable the detoxication process in the body to facilitate morning urination and defecation ( toilet hygiene )

17. Healthy balanced diet Protein 1 g/kg BW animal source lean meats, skinless chicken, eggs , fish, plant source tofu, tempeh, walnuts, almonds Energy source sweet potato , potato, rice, pasta, noodles Veggies & Fruits (rainbow colored) spinach, bok choy, broccoli, cauliflower, cabbage (cruciferous); beets, carrot, tomato, cucumber, pineapple, water melon, apple, grapes, berries Milk low fat, whey, almond Fluids 2.5 L daily : coffee, green tea, chai tea, yogurt Honey, dates ( kurma ) Spices in daily cooked meals: ginger, garlic , lemon, turmeric/curcumin

18. Healthy lifestyle (2) Brain exercise by reading, comprehending, note writing, learning new languages, new words to increase current vocabulary. Social interaction both personal and online with friends, family, coworkers, junior and senior classmates, children and grand children Mindfulness ( stress management) : quality awareness, being aware of your present situation and acceptance of feelings, thoughts and bodily sensations Deep breathing exercise, meditation through yoga, Tai chi, senam lansia

19. Growing old vs Getting old (signs) Signs Features Loss of appetite Good appetite : optimism Physical activity vs Sedentary Immunity; standing on one leg Enough (night) sleep 6-7hrs; duration & quality Communication ability vs solitude Lost of words, anxiety, isolation Learning ability Information-rich, Skills, hobbies Mental state Positive attitude in life

20. Longevity Habits Habit Yes & No Eat balanced diet Yes eggs 1xwk & Omega3 3xwk No processed & sugary Exposure to Sunlight Yes morning No mid day Exercise Yes walking, weights, mood, lowers cholesterol Keep Hydrated Yes 8 glasses/ 2L/ dy against toxins & biological clock Night sleep Yes 6-7hrs cognition, memory, hormones Managing stress Yes deep breathing 3x3 Social communication Yes family, friends, co-workers Maintain positive life outlook Yes optimism, hobbies, goals, gratefulness Brain stimulation Yes reading, writing, skills, hobbies Checkups Yes access to family medicine on/off line

21. Signs of Dementia Signs Brain affected Disorientation Wandering; parietal lobe Poor distance judgment Depth perception, visual problems, starvation, falls Repetition Retaining new information, memory, amyloid plagues Consistently losing things Recall deterioration, placing unfamiliar places, keys Use of memory aids Natural memory decline, sticky notes everyday tasks Confusion * New information storage, time, place, people Speaking problem* Finding words. Language centers Problem solving skills* Cognitive dysfunction, executive function, activities Memory issues* New connections, short memory, event, conversations Social withdrawal* Embarrassment, confusion, anxiety, solitude Personality changes* Behavior, emotional, paranoia, personality, frontal Mis-identity Confusion, object disorientation, recognition, memory

22. Brain ageing Location Function Pre frontal cortex Intelligence; judgment; behavior Parietal cortex Motoric; spatial cognition; motor control eyes & extremities Temporal cortex Emotions; sensory; memories; language Mid brain (mesencephalon) Relay system vision & hearing; sleep cycle

23. Brain Foods Food Function Nuts : almond, walnut Seeds : flax, chia Brain cell membrane; BDNF; cognition, learning, memory, neuronal plasticity PUFAs, B. E, Mg, Zn, omega3. polyphenols Leafy greens : Kale, spinach Myelin health; cognition; lutein, carotenoids, K2, E Mood, Learning, Memory, fiber: blood sugar control Berries : red, blue, purple, Flavonoids, Anthrocyanin , nerve transmission, cognition, memory Olive oil Polyphenols; anti-inflammatory, LDL Whole grains Glucose, B6, 12, E; neurotransmitters, cognition, learning, mood, stabilize blood sugar Cocoa (70%) Cognition, thinking, memory, focus, reaction, verbal fluency; endothelial plasticity, oxidative stress

24. Brain Foods (2) Food Function Legumes : beans, lentils, chic, peas B9, folate, 12; neurotransmission, cognition, vascular health, anti-inflammatory, stabilizes cholesterol Avocado (Fruit) MUFA; O2 blood flow. E, free radicals Spice : Turmeric Cognition, anti-inflammatory, neurodegeneration, blood flow, BDNF cell growth Pumpkin seeds Fe, Mg (reduces stress), Zn (nerve signaling), Cu (control nerve signaling), oxygen transport, neurodegeneration; omega3 : 6; cell structure, integrity, communication; omega6:3 ratio: 1:1, 2:1 Citrus C (100%), flavonoids, neurotransmission, brain elasticity’ oxidative damage

25. Dementia Supplement Feature Cobalamin B12; cognition; > 2.4 micro g Ashwagandha Indian ginseng; adaptogen; 300-500 mg Gingko biloba Cognition; brain blood flow; Alzheimer; anxiety Omega3 EPA & DHA; brain & retina ; dementia; 100mg

26. Collagen – rich food (Glycine) Food Broth Meat, chicken Citrus Orange Strawberry Soy Genistein Nuts Almonds; Cu, E Leafy greens Bell pepper Yellow, red, beta carotene, capsain Garlic Avacado

27. Glycine precursor of Glu Properties : Anti-inflammatory Leaky gut Auto immunity Hair greying (catalase) Detoxication : Acidity, Gout Insulin stabilizer

28. Precursor (2) Preventative : Kidney stones Stress Medication Toxin

29. Gut microbiome (pop. 39 Trillion) Type of Food Fiber Prebiotics Psyllium; butyrate Artichoke (Thistle) Asparagus; inulin; bifida bacterium Bile Lipase Fermented food Yogurt; kimchi

30. Stem cell regeneration No Yes Alcohol Med diet : fruits; veggies; lean meat; olive oil Sugar Green/ black tea : Epigallocatechin Gallate (EGCG) Stress : cortisol Hot chocolate : cocoa 70%; flavinois ; blood flow

31. Telomeres Food Feature Carotenoids Carrots; alpha & beta carotene Green tea Antioxidation; EGCG Flax seeds & nuts Omega3 Berries Antioxidants

32. Turmeric Function Features Kidney health Antioxidant enzymes Liver health Pancreas Cholesterol LDLs Endothelial linings Endothelial functions Angiogenesis Cancer; cell apoptosis; cytotoxicity; mutation Brain health Alzheimer; amyloid plagues; cognition Bloating Peptic ulcers; Crohn’s disease; ulcerative colotis Immunity Antimicrobial; cytokines

33. Salam, Namaste, Mahalo

34. Fortunate people (70+ yr.; adapted Wada) Walking daily Deep breathing regularly Exercise daily Rehydrate daily Chew food longer Brain exercise Limit drug use Limit refine sugars Love & Not Hate Be active outdoors daily Eat everything (but in moderation) Don’t be consumed with Hate Live with (controlled) disease Find the way to the Mountain Sleep but don’t force it Do happy things (hobbies) Have access to family doctor Don’t force yourself Don’t stop learning Don’t be greedy and vane

35. Fortunate people (2) Innocence (pure & clean) Troublesome shows interest Doing good to others Live leisurely Desire is the source of longevity Be an optimist Be cheerful Life is in your hands Be calm